- Design
- Systematic review and meta-analysis of 26 mostly retrospective studies
- Population
- 3,133 adults treated with radiotherapy for mucosal head and neck cancer
- Primary outcome
- Prevalence of lymphoedema
- Effect
- 49% (95% CI 36–62%); grade 2 or above 32% (14–59%); I² 94%
This systematic review and meta-analysis pooled 26 studies of 3,133 adults treated with radiotherapy for mucosal head and neck cancer. Most studies were retrospective and single-arm, and definitions of lymphoedema varied.
The pooled prevalence of lymphoedema was about 49%. Internal lymphoedema, affecting the pharynx and larynx, was reported in about 45% and external, affecting the face and neck, in about 37%. Clinically significant lymphoedema, grade 2 or above, was about 32% where severity was graded.
The estimates are imprecise: heterogeneity was very high, certainty very low, and there were signs that small studies inflated the figure. But even at the lower end of the intervals, lymphoedema is common enough to plan for.
Internal lymphoedema contributes to swallowing difficulty, voice change and airway narrowing, and is easily attributed to other late effects. Survivorship follow-up should look for it, and referral to lymphoedema therapy, which in India is often limited to a few centres, should be planned early.
- Examine for external neck and facial swelling at each follow-up after head and neck radiotherapy.
- Look for internal lymphoedema on endoscopy when patients report new swallowing or voice change.
- Use a standard grading scale so change can be tracked over time.
- Refer early for lymphoedema therapy where it is available.
- Warn patients before treatment that swelling is common and can be treated.
Why it matters
A late effect seen in about half of survivors is still not routinely looked for in many clinics.
Don't overread it
Very low certainty with inconsistent definitions; the exact prevalence is uncertain.
The statistics, in plain English
49% is the central estimate, but the interval runs from 36% to 62% and heterogeneity (I² = 94%) shows studies disagreed a great deal. The figure tells you lymphoedema is common, not exactly how common it will be in your patients.
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